The treatment of children and young adults with cancer is known as Paediatric Oncology.
What is Paediatric Oncology?
Oncology refers to the branch of medicine that specialises in the study, treatment and management of cancer. A doctor who specialises in oncology is called an oncologist. Paediatric Oncology is the speciality that focuses on cancer in neonates, children, and young adults. A doctor who specialises in paediatric oncology is called a paediatric oncologist.
Narayana Health is a children's cancer hospital that has an expert team with experience in treating the most complex paediatric cancers. There is a difference in the treatment of adult and childhood cancers because the way cancer presents in children is quite different. The reaction of a child’s cancer to the treatment is also different. Most children do not have underlying health issues that adult patients have. Children usually have higher chances of recovery when compared to adults, but they have an added risk of long term side effects from the treatments.
Narayana health hospitals have medical facilities to treat
Tumors that are treated at Narayana Health:
- Wilm's tumor (kidney)
- Hepatoblastoma (liver)
- Neuroblastoma (adrenal)
- Rhabdomyosarcoma (soft tissue tumor)
- Ewing's tumor (PNET)
- Retinoblastoma (eye)
Types of Paediatric Cancer
Cancers in children are of two broad types:
- Hematological or Blood related Cancers
- Solid Tumours - Tumours that arise from other organs
Haematological or Blood-related Cancers
Leukaemia in children is usually of two types:
- Acute lymphoblastic leukaemia (ALL)
- Acute myeloid leukaemia (AML)
These are tumours that originate from other organs and parts of the body. They are usually :
- Wilm's tumour
Wilm’s tumours is a kidney cancer and is one of the most common paediatric cancers. When a kidney is being developed in the fetal stage, some of its cells will become glomeruli that perform the filtration function, while others will become nephrons which are the tubes in the kidney. These cells mature at the age of 3 or 4 years of age. If the normal development does not occur these cells become a mass that grows out of control. The mass is always cancerous and is called a Wims tumour or a nephroblastoma. If the early cells of the kidney do not develop into glomeruli of nephrons, clusters of the immature cells may form in the kidneys when the baby is born. Usually, these cells mature by the time a child is 3 or 4 years old, but some may grow out of control, forming a mass of immature cells. This mass is called a Wilms tumour or a nephroblastoma. It is different from kidney cancer that is found in adults because a Wilms tumour can become malignant which means it can spread to other parts of the body. When the tumour is in both the kidneys it is called bilateral, and when it’s in one kidney it is called unilateral. Sometimes it can start in one kidney and then spread to the other.
This is the most commonly found type of liver cancer in children and is found in children under the age of three.
Neuroblastoma is a solid cancerous tumour in children that starts outside the brain, in the nerve cells of infants and young children. Though it is often found to start in the nerve tissue of the adrenal glands it can also start in the chest, neck, pelvis, abdomen, or near the spine.
The adrenal glands are on the top of the kidneys and are the producers of hormones to control functions such as the blood pressure and heart rate. In the fetus, neuroblasts are the immature nerve cells that later mature into either nerve cells or adrenal medulla cells. The adrenal medulla cells are the cells that are found in the adrenal gland. When the neuroblasts do not reach maturity properly they grow into a tumour. This can occur even before birth, and in infants and children under the age of 5.
Sarcomas are cancer that develops in the connective tissues of the body. They are also called soft tissue sarcoma or STS. The mesenchymal cells are the cells that develop into the striated or skeletal voluntary muscles. When they do not develop properly they can form tumours called rhabdomyosarcoma. They are most often found in children and young adults, and can occur anywhere in the body.
- Ewing's Tumour or Sarcoma
Ewing sarcoma is a cancer of the bone, or the soft tissue outside the bone. The bone tumours are usually found in the spine, chest, rib, pelvis, arm or leg areas while the soft tissue tumours can be found in the pelvis, thigh, foot, chest wall or spine.
This is a very rare cancer that is found in the retina, it is usually unilateral or in one eye. When it is in both eyes it is called bilateral. When retinoblastoma cancer spreads it can affect the bones, bone marrow, lymph nodes, and the brain and spinal cord (although it’s quite rare). Though babies can be born with this cancer, it is rarely diagnosed at birth. The chances of cure are higher when cancer has not spread beyond the eye. At Narayana Health the focus is on treating the retinoblastoma while preserving vision.
The diagnosis of cancer in children is usually performed by a paediatric oncologist. Cancer will be assigned a stage and will be treated according to the stage.
Some of the commonly used diagnostic tests in pediatric oncology are:
- Blood Tests: Some types of cancer are characterised by higher levels of substances called biomarkers or tumour markers in the blood.
- Biopsy: A definitive diagnosis of a cancer is done after studying the suspected tissue. A tissue sample is obtained through a procedure called a biopsy. The sample can be taken through a needle or a surgical incision depending on the type and location of the tumour.
- Bone Scan, Bone Marrow Biopsy or Aspiration: Bone scans are used to detect anomalies in the bones. Bone marrow samples are obtained through bone marrow biopsy or aspiration of further study and diagnosis.
- CT Scan: A computed tomography scan is the diagnostic tool by which two-dimensional images of the internal structure of the body by using X-rays and a contrast dye. There is an exposure to radiation which outweighs the benefits of the scan. For patients who cannot undergo a CT scan, an MRI scan is advisable.
- Magnetic Resonance Imaging (MRI): MRI scans use a strong magnetic field to obtain pictures on the inner structures of the body. They may sometimes use contrast dye for more clarity.
- Positron Emission Tomography (PET): PET scans give more detailed images of the body. PET-CT scans use a combination of PET and CT technology to obtain pictures. PET scans use radioactive material called tracers that are injected into the bloodstream.
Treatment & Preventions
The treatment of childhood cancers is different from that of adult cancer as children react differently to treatments. As child cancers grow quickly, chemotherapy is frequently used in pediatric oncology treatments. Children also recover from high doses of chemo better than adult patients do. Radiation therapy has more serious side effects in children than it does in adults. Since children are in the development stage, the damage that could be caused by radiation to healthy tissue and organs would have more serious long term consequences. Some cancer treatments follow the treatment by chemotherapy with stem cell transplants.
Surgery to remove cancerous tumours is performed to remove all the cancerous cells and a small margin of normal cells around it. Since there is always the chance of having some cells left behind, it is usually followed by chemotherapy.
Being diagnosed and treated for cancer can upset a child, it can cause emotional and other effects. At Narayana Health children's cancer hospital, palliative care includes supporting the child and the caregivers through this process.
When cancer cannot be detected in the body after treatment it is called remission or NED (no evidence of disease). Remission can be temporary or permanent, and sometimes recurrence does occur and cancer returns.
Cancers in children are not detected at first because most symptoms are similar to common childhood illnesses or injuries. However, when the symptoms do not go away, they should be checked by a qualified medical practitioner.
Some of the common signs are:
- Pain in an area of the body that does not go away
- Recurrent headaches with or without vomiting
- Sudden vision changes
- Paleness and loss of energy
- An unexplained or unusual lump or swelling
- Fever or illness that does not go away
- Sudden weight loss with no reason
- Easy to bruise or bleed
Though all these symptoms could be caused by health issues that are not cancer, it is best to have them checked and treated.
There are different drugs that are used for chemotherapy and their side effects vary. The most common side effects are hair loss, nausea, vomiting, fatigue, appetite loss, diarrhoea and a higher risk of infection. Side effects get better after the treatment has stopped.
The more common side effects of radiation therapy are mild skin reactions, stomach upset, and fatigue.
- Continued and unexplained weight loss
- Development of a lump or mass, especially in the neck, chest, abdomen, pelvis or armpits
- Constant infections
- Headaches accompanied often with early-morning vomiting
- Increased swelling or persistent pain in the bones, joints, back or legs
- Development of excessive bruising, bleeding or rash
- Persistent nausea
- Development of a whitish colour behind the pupil
- Constant tiredness or noticeable paleness
- Eye or vision changes that occur suddenly and persist
- Recurrent or persistent fevers of unknown origin.
Paediatric oncologists/haematologists offer the treatment and management of the following conditions in children.
- Cancers including leukaemia, lymphomas, brain tumours, bone tumours and solid tumours
- Bleeding disorders
- Diseases of blood cells that may include disorders of white cells, red cells and platelets
The most common cancer of bone tissues in children is osteosarcoma and Ewing’s sarcoma. While osteosarcoma develops around the knees, Ewing’s sarcoma may affect the bones of the pelvis, thigh, upper arm or ribs.
The symptoms of leukaemia can vary from one child to another. Some symptoms may be confused with those of common childhood diseases. The following are some common symptoms of leukaemia although they do not necessarily mean that the child has leukaemia.
- Bleeding and bruising more than expected after a minor injury
- Stomach ache and poor appetite
- Difficulty in breathing
- Frequent or prolonged bouts of viral or bacterial infections
- Swelling in the neck, in the groin or above the collarbone
- Aches and pains of the bones and joints
Acute lymphoblastic leukaemia is treated in the following three phases.
- Induction – to destroy the leukaemia cells in the blood and bone marrow and put the disease into remission
- Consolidation – to eliminate the remaining cancer cells in the body that could possibly grow and result in the relapse of leukaemia
- Maintenance – In this phase, the cells that might have survived the first phases are targeted and destroyed. These treatment phases use the following four types of treatments.
- Chemotherapy – Powerful medicines may be injected into the bloodstream or given by mouth. They can travel through the body and kill cancer cells from dividing and making more cells.
- Stem cell transplant – New blood cells from a donor’s blood or bone marrow are used to replace the blood-forming cells in the patient’s bone marrow that were destroyed during chemotherapy or radiation therapy.
- Radiation therapy – High energy X-rays or other types of radiation are used to destroy cancer cells.
- Targeted therapy – Medicines and other treatments are used to target specific cancer cells and specifically attack them without affecting the healthy normal cells.
Most children with acute lymphoblastic leukaemia go into remission within weeks after their treatment begins. Usually, 90% of them can be cured. Besides, patients are considered to be cured after ten years in remission.